AccountId: 011433970860
ContactId: 168f4885-dd0b-4450-a3a4-17991dbd7fd3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362649 ms
Total Talk Time (AGENT): 162275 ms
Total Talk Time (CUSTOMER): 201260 ms
Interruptions: 5
Overall Sentiment: AGENT=1.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/168f4885-dd0b-4450-a3a4-17991dbd7fd3_20250211T18:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, good afternoon, [PII]. How are you?
[AGENT][POSITIVE] I'm great. How are you?
[CUSTOMER][NEUTRAL] Good good um well I have a question because I actually submitted a couple of claims and they tell me, I mean it was for the deductibles of $25 and they're telling me that.
[CUSTOMER][NEUTRAL] They don't, I didn't get the money, so I was wondering why.
[AGENT][NEUTRAL] May I have your policy number and I'll pull up your account.
[CUSTOMER][NEUTRAL] Yeah, sure. It's uh 02064088.
[AGENT][NEUTRAL] May I have your first name and a good callback number?
[CUSTOMER][NEUTRAL] Uh, call back number is [PII] and my full name is [PII] and my last name [PII]
[AGENT][NEUTRAL] Thank you, [PII], can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah, my mailing address is um my date of birth is [PII]. My email address is [PII], and my email is uh [PII].
[AGENT][POSITIVE] Thank you for verifying that.
[CUSTOMER][NEUTRAL] The main
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Go ahead. No.
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim.
[AGENT][NEUTRAL] So it looks.
[CUSTOMER][NEUTRAL] OK, I understand.
[AGENT][NEUTRAL] Under this claim 3558055 for data service 16, they are asking for the diagnosis code.
[AGENT][NEUTRAL] For 124. They're asking for the diagnosis code.
[CUSTOMER][NEUTRAL] OK, so my question is, the diagnosis code is not in the receipt that the doctor gives me.
[CUSTOMER][NEUTRAL] That's a policy that has to go through the doctor's office.
[AGENT][NEUTRAL] OK. So let me
[CUSTOMER][NEUTRAL] So how do I go online?
[AGENT][NEUTRAL] Let me look up your claim.
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because we cannot take diagnosis codes over the phone. They have to be in writing.
[CUSTOMER][NEGATIVE] No, but I understand, but it's not the doctors that are filing, and they're not giving me the, the, the, it's my co-pay.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Last time I did it.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, basically this is what happened. Last time I sent one.
[CUSTOMER][NEUTRAL] And they just told me to send the receipts, and I did, and I got them last year.
[CUSTOMER][NEUTRAL] But this year, you're asking me for the medical code or whatever.
[AGENT][NEUTRAL] Yes, there's always, it always has to have a diagnosis code. So I do apologize, the system is slow. I just want to see the image that you submitted.
[CUSTOMER][NEGATIVE] It doesn't make any sense.
[CUSTOMER][NEUTRAL] So so.
[AGENT][NEUTRAL] I'm just waiting on it to load because, OK, so it's opening up and it's [PII] and it gives you a receipt. So on this receipt right here, what I would do, since they did not give you any information and this policy does allow you to for visit for $25 I would just write the reason, which is the diagnosis code is the reason for your visit. Headache, backache, stomach ache. That's what a diagnosis code is.
[CUSTOMER][NEUTRAL] Braver.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Or like checkup or whatever, yeah. Oh, OK.
[AGENT][NEUTRAL] Yes, ma'am. Yes ma'am. So I would just write that on there for each data service that we're requesting and resubmit it so that they can get this processed to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, then the other question.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Regarding my policy, I was in the hospital for 2 days. Obviously that is being handled by memorial.
[CUSTOMER][NEUTRAL] But, um, what does it cover?
[AGENT][NEUTRAL] So under your inpatient benefits, let me get that pulled up.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It will pick up your co-pays, your coinsurance and our deductibles up to $5000. Your inpatient is per occurrence, which means per confinement up to $5000.
[CUSTOMER][NEUTRAL] OK, OK, so basically that goes towards my copay that I.
[CUSTOMER][NEUTRAL] Uh, maybe I'm gonna, let me see if I understand, sorry, I'm being slow here. So basically, let's say United pays for every for the whatever the bill, right? And then the leftover of the co-pays is covered by you guys, up to $5000. OK.
[AGENT][NEUTRAL] No, no, you're fine.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct. That is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, cause my husband was in the impression that he got back, I mean, that we got back like $1000.
[CUSTOMER][NEUTRAL] When we were in the hospital.
[AGENT][NEUTRAL] Not
[AGENT][NEUTRAL] Not for your inpatient, for your inpatient it's 5000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, OK. That's very confusing all this insurance stuff. But thank you so much. So basically, I just need to go into, I'll just call the doctor and ask him to give me the code for.
[AGENT][POSITIVE] You're so welcome.
[CUSTOMER][NEUTRAL] For uh the reason I was at the doctor's office.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you cannot obtain them from them and you know, just write it on your sheet and get it in. We just have to have it in writing.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Oh, OK, OK, so basically like I went to get my regular checkup and then because I was in the hospital, I had to do the follow up. Can I write that in the receipt?
[AGENT][NEUTRAL] Yes, you were in the hospital for a backache, for a stomach ache, for
[CUSTOMER][NEUTRAL] Long. OK. Yeah, OK, OK.
[AGENT][NEUTRAL] Headaches. Yes, yes. It, yes, ma'am.
[AGENT][POSITIVE] And then send that in and we'll get it taken care of.
[CUSTOMER][POSITIVE] Thank you so much. You're.
[CUSTOMER][POSITIVE] OK, thank you, [PII]. Have a wonderful day.
[AGENT][POSITIVE] You're so welcome, [PII], and thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] You're very helpful. OK. OK.
[CUSTOMER][POSITIVE] Take care. Bye-bye.